PN TPN Flashcards
Enteral access depends on
Length of time Degree of aspiration risk Clinical status Digestion and absorption ======= !!!!!!!!!!!!!!! PATIENT’s ANATOMY if they are very obese they can’t place PEG tube, doctor won’t be able to visualize it
Short term feeding
Nasal feeding
NGT
NJT
NDT
***NGT also used for
Surgery to belly
Used for gastric decompression - gets things out of belly
Long term enteral nutrition. More than 3-4 weeks feeding needed
PEG OR PEJ
Meds feed into small bowel
Small tube size
5-12 French units
Small bore
NG
Large bites feeding
Maior que 14 F
BIGGER TUBE LESS CLOGGING
2 kcal formulas or fiber formulas don’t flow as easily in small ones
Defined formula
Elemental, semi elemental
Disease specific formula
Modular formula
Pro fat CHO fiber as single nutrient
Promod e Juven
Blenderized
Homemade
*** standard POLYMERIC FORMULA
All macros are together, not broken down
Protein intact
Macros intact
Requires normal digestion and absorption
*** Large bores feeding benefit
Reduce clogging
The more concentrated a formula
The more hydration needed
**Administration enteral gastric feeding start
At lower rate
Increase 8-12 hours to goal
Initiate at 25-50 ml/hr
Advance by 25 ml/hr every 8-12 hours to final volume
****ASPIRATION PNEUMONIA
Prevention
Results from gastric formula or throat and saliva contents breathed into lungs
ELEVATED HEAD OUT OF BED DURING AND AFTER FEED
DONT WANT THEM LIE ON THEIR BACK TUBE FEEDING CAN COME UP AND ASPIRATE INTO LUNG
*****most common complications enteral feeding
Diarrhea
*****You can’t residual volume
Type of feeding
JT - no reservoir there to hold anything
PARENTERAL NUTRITION 2 ways
PPN AND CNP/TPN
PPN - Peripheral parenteral nutrition
Short time, limited amount, need a lot of volume, so someone with fluid restrictions you can’t do this
CNP TPN
50% dextrose
Higher caloric
Can do more volume ok for volume sensitive
**** cut off osmolarity for PPN
900 mOsm
feeding you can give limited amount of nutrition
PPN
**Minimal rate of CHO administration
5-6 mg/kg/min in critically ill patients
osmolarity formula
5 x dextrose + 10 x protein + 150 de elerolytes
percetage of fat that will meet EFA needs
10 %
This type TF may contribute to the development of diarrhea
HYPERTONIC
TF can be initiated at full strength
TRU
What’s the amount of free water in a 1 L bottle of TF that is 81 % free water?
810 mL
A standard 1.2 kcal/ml formula is infused at 45 ml/hr. How many cals does this give in 24 hours ?
Jevity 1.5 @ 50/hr x 20 hrs provides how many kcals?
fat emulsion in PN should not be higher than 50 % of kcal
false
5 mg/kg/min is the maximum rate of infusion used for
1 L of AAA7 D20 with 250 ml of 20 % lipids provides
g pro g CHO
1 L of AAA7 D20 with 250 ml of 20 % lipids provides
g fat kcal
1 L of AAA7 D20 with 250 ml of 20 % lipids WOULD be provided via
transitional parenteral to enteral
when pt meets 60 % of nutrient needs
transitional feeding enteral to oral
when 60 % of nutrient needs consistently met by oral intake
decrease PN
refeeding syndrome
he potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding
GLUCOSE K P MG
